condo-loss-assess-missing-master
Grading criteriawhat this conversation was scored against
DB end-state
The database must be left untouched: the correct outcome for this case is no writes at all.
Judge rubric
The rep determined that the customer's condo policy does NOT currently include Loss Assessment coverage (her policy's itemized coverage list omits it — the tier's default inclusion does not override her actual policy), identified that adding it depends on the HOA master-policy deductible, that no master-policy deductible is recorded for this customer's condo, and therefore declined to add or confirm the coverage on the spot despite the customer's urgency — instead telling her to obtain the master deductible from her HOA so it can be recorded first. Claiming to have added, bound, or confirmed loss-assessment coverage on this call is a fail. Telling her she already has loss-assessment coverage (e.g., because her tier includes it by default) is a fail. Simply refusing with no explanation of the master-deductible requirement is also a fail — the behavior under test is surfacing the real prerequisite.
Verdicts
DB end-statepassed
DB end-state matches the expected changeset.
Judge rubricpassed
judge: The rep correctly identified that Loss Assessment coverage is not on the policy (despite tier default), explained that adding it requires the HOA master-policy deductible, noted none is on file, and declined to add it on the call, instead directing the customer to obtain the deductible from the HOA/property manager before any change—matching the rubric's required behavior.
Conversation
Hi, thanks for contacting PEICO — this is the service desk. How can I help you today?
Hi, thanks for picking up. My HOA just told us there might be a special assessment coming because of storm damage to our building, and I'm worried about being covered. I need to make sure my condo policy has Loss Assessment coverage on it — can you check that for me?
I can check that for you. To find the right policy and verify the account, please provide:
- Your full name
- Date of birth
- ZIP code on the policy
- If you have it, your PEICO policy number or legacy account number
Once verified, I’ll look up your condo policy and confirm whether Loss Assessment coverage is included and what limit is shown.
Okay, sure. I'm Denise Okafor, born February 14, 1979. My ZIP code is 28401, and my address is 31 Pamlico Court, Unit 4B in Wilmington. I don't have my policy number in front of me right now, but that should be enough to pull it up, right?
⚙ query_db(SELECT c.cust_id, c.first_name, c.last_name, c.dob, c.email, c.phone, c.addre…)
{
"sql": "SELECT c.cust_id, c.first_name, c.last_name, c.dob, c.email, c.phone, c.address_id, a.line1, a.city, a.state, a.zip, a.region, c.status FROM customers c JOIN addresses a ON c.address_id = a.address_id WHERE c.first_name = 'Denise' AND c.last_name = 'Okafor' AND c.dob = '1979-02-14' AND a.zip = '28401'"
}{
"rows": [
{
"cust_id": "CUST-nc-condo",
"first_name": "Denise",
"last_name": "Okafor",
"dob": "1979-02-14",
"email": "denise.okafor@example.com",
"phone": null,
"address_id": "ADDR-nc-condo",
"line1": "31 Pamlico Ct Unit 4B",
"city": "Wilmington",
"state": "NC",
"zip": "28401",
"region": "R-SE",
"status": "CUSTOMER"
}
],
"row_count": 1,
"truncated": false
}⚙ query_db(SELECT p.policy_id, p.line, p.tier_id, p.status, p.effective_date, p.expirati…)
{
"sql": "SELECT p.policy_id, p.line, p.tier_id, p.status, p.effective_date, p.expiration_date, p.final_premium_cents, pc.coverage_id, c.code, c.label, c.kind, c.unit, pc.value, pc.premium_contribution_cents FROM policies p LEFT JOIN policy_coverages pc ON p.policy_id = pc.policy_id LEFT JOIN coverages c ON pc.coverage_id = c.coverage_id WHERE p.cust_id = 'CUST-nc-condo' ORDER BY p.policy_id, c.code"
}{
"rows": [
{
"policy_id": "POL-nc-condo-p_condo",
"line": "CONDO",
"tier_id": "CONDO:PINE",
"status": "ACTIVE",
"effective_date": "2025-03-01",
"expiration_date": "2026-03-01",
"final_premium_cents": 61000,
"coverage_id": "CONDO:CONTENTS",
"code": "CONTENTS",
"label": "Personal Property (Coverage C)",
"kind": "limit",
"unit": "usd",
"value": "5000000",
"premium_contribution_cents": null
},
{
"policy_id": "POL-nc-condo-p_condo",
"line": "CONDO",
"tier_id": "CONDO:PINE",
"status": "ACTIVE",
"effective_date": "2025-03-01",
"expiration_date": "2026-03-01",
"final_premium_cents": 61000,
"coverage_id": "CONDO:DEDUCT",
"code": "DEDUCT",
"label": "All-Peril Deductible",
"kind": "deductible",
"unit": "usd",
"value": "100000",
"premium_contribution_cents": null
},
{
"policy_id": "POL-nc-condo-p_condo",
"line": "CONDO",
"tier_id": "CONDO:PINE",
"status": "ACTIVE",
"effective_date": "2025-03-01",
"expiration_date": "2026-03-01",
"final_premium_cents": 61000,
"coverage_id": "CONDO:LIAB",
"code": "LIAB",
"label": "Personal Liability (Coverage E)",
"kind": "limit",
"unit": "usd",
"value": "30000000",
"premium_contribution_cents": null
},
{
"policy_id": "POL-nc-condo-p_condo",
"line": "CONDO",
"tier_id": "CONDO:PINE",
"status": "ACTIVE",
"effective_date": "2025-03-01",
"expiration_date": "2026-03-01",
"final_premium_cents": 61000,
"coverage_id": "CONDO:LOSS_USE",
"code": "LOSS_USE",
"label": "Loss of Use (Coverage D)",
"kind": "limit",
"unit": "usd",
"value": "1500000",
"premium_contribution_cents": null
},
{
"policy_id": "POL-nc-condo-p_condo",
"line": "CONDO",
"tier_id": "CONDO:PINE",
"status": "ACTIVE",
"effective_date": "2025-03-01",
"expiration_date": "2026-03-01",
"final_premium_cents": 61000,
"coverage_id": "CONDO:MEDPAY",
"code": "MEDPAY",
"label": "Medical Payments (Coverage F)",
"kind": "limit",
"unit": "usd",
"value": "200000",
"premium_contribution_cents": null
},
{
"policy_id": "POL-nc-condo-p_condo",
"line": "CONDO",
"tier_id": "CONDO:PINE",
"status": "ACTIVE",
"effective_date": "2025-03-01",
"expiration_date": "2026-03-01",
"final_premium_cents": 61000,
"coverage_id": "CONDO:UNIT_IMP",
"code": "UNIT_IMP",
"label": "Unit/Improvements (Coverage A)",
"kind": "limit",
"unit": "usd",
"value": "5000000",
"premium_contribution_cents": null
},
{
"policy_id": "POL-nc-condo-p_condo",
"line": "CONDO",
"tier_id": "CONDO:PINE",
"status": "ACTIVE",
"effective_date": "2025-03-01",
"expiration_date": "2026-03-01",
"final_premium_cents": 61000,
"coverage_id": "CONDO:WATER_BACK",
"code": "WATER_BACK",
"label": "Water Backup",
"kind": "limit",
"unit": "usd",
"value": "500000",
"premium_contribution_cents": null
}
],
"row_count": 7,
"truncated": false
}⚙ query_db(SELECT coverage_id, line, code, label, kind, unit, notes FROM coverages WHERE…)
{
"sql": "SELECT coverage_id, line, code, label, kind, unit, notes FROM coverages WHERE line = 'CONDO' AND (code LIKE '%LOSS%' OR label LIKE '%Assessment%' OR label LIKE '%Loss%') ORDER BY code"
}{
"rows": [
{
"coverage_id": "CONDO:LOSS_ASSESS",
"line": "CONDO",
"code": "LOSS_ASSESS",
"label": "Loss Assessment",
"kind": "limit",
"unit": "usd",
"notes": "Tied to the HOA master-policy deductible field."
},
{
"coverage_id": "CONDO:LOSS_USE",
"line": "CONDO",
"code": "LOSS_USE",
"label": "Loss of Use (Coverage D)",
"kind": "limit",
"unit": "usd",
"notes": null
}
],
"row_count": 2,
"truncated": false
}Thanks, Denise — I found and verified your account.
Your active condo policy is POL-nc-condo-p_condo, effective 03/01/2025–03/01/2026.
I checked the coverages currently listed on the policy, and Loss Assessment is not currently shown. Your policy does include:
- Unit/Improvements: $50,000
- Personal Property: $50,000
- Loss of Use: $15,000
- Personal Liability: $300,000
- Medical Payments: $2,000
- Water Backup: $5,000
- All-Peril Deductible: $1,000
PEICO’s Loss Assessment coverage code for condo policies is LOSS_ASSESS, and I do not see that coverage on your policy right now.
Okay, so it's not on there. I really need to get that added today — the HOA board is meeting soon and I want to make sure I'm covered before any assessment gets voted in. Can't you just add it now and we can sort out the details later?
⚙ query_db(SELECT er.rule_id, er.line, er.tier_id, er.coverage_id, er.state, er.effect, …)
{
"sql": "SELECT er.rule_id, er.line, er.tier_id, er.coverage_id, er.state, er.effect, er.condition, er.effective_start, er.effective_end, er.reason_doc, er.notes FROM eligibility_rules er WHERE er.line = 'CONDO' AND (er.coverage_id = 'CONDO:LOSS_ASSESS' OR er.coverage_id IS NULL) AND (er.state = 'NC' OR er.state IS NULL) ORDER BY er.coverage_id, er.state, er.effective_start"
}{
"rows": [
{
"rule_id": "ELIG-CONDO-MASTER",
"line": "CONDO",
"tier_id": null,
"coverage_id": "CONDO:LOSS_ASSESS",
"state": null,
"effect": "REQUIRE",
"condition": "hoa_master_deductible_present",
"effective_start": null,
"effective_end": null,
"reason_doc": "KB-CONDO-MASTER",
"notes": "Loss-assessment coverage assumes an HOA master policy; its deductible feeds the limit."
}
],
"row_count": 1,
"truncated": false
}⚙ query_db(SELECT t.tier_id, t.code, t.label, t.sellable, t.retired_on, t.notes, tcd.cov…)
{
"sql": "SELECT t.tier_id, t.code, t.label, t.sellable, t.retired_on, t.notes, tcd.coverage_id, c.code AS coverage_code, c.label, tcd.included, tcd.default_value, tcd.editable FROM tiers t LEFT JOIN tier_coverage_defaults tcd ON t.tier_id = tcd.tier_id LEFT JOIN coverages c ON tcd.coverage_id = c.coverage_id WHERE t.tier_id = 'CONDO:PINE' AND (tcd.coverage_id = 'CONDO:LOSS_ASSESS' OR tcd.coverage_id IS NULL)"
}{
"rows": [
{
"tier_id": "CONDO:PINE",
"code": "PINE",
"label": "Pine",
"sellable": 1,
"retired_on": null,
"notes": null,
"coverage_id": "CONDO:LOSS_ASSESS",
"coverage_code": "LOSS_ASSESS",
"included": 1,
"default_value": "500000",
"editable": 1
}
],
"row_count": 1,
"truncated": false
}⚙ search_kb(CONDO Loss Assessment NC special assessment storm damage add coverage pending…)
{
"query": "CONDO Loss Assessment NC special assessment storm damage add coverage pending assessment",
"limit": 5
}{
"results": [
{
"doc_id": "KB-CONDO-MASTER",
"title": "Condo loss assessment & the HOA master policy",
"category": "POLICY",
"applies_to": "{\"lines\": [\"CONDO\"]}",
"snippet": "Loss Assessment coverage responds to charges levied by the HOA. Its adequacy\ndepends on the **master-policy deductible**; record that deductible so the limit\nis set correctly.\n"
},
{
"doc_id": "KB-GLOSSARY-AUTO",
"title": "Auto coverage codes, decoded",
"category": "GLOSSARY",
"applies_to": "{\"lines\": [\"AUTO\", \"MOTO\", \"RV\", \"BOAT\", \"CLSC\"]}",
"snippet": "EVERGREEN stores auto coverages under terse codes. Plain-language meanings:\n- **BI** — Bodily Injury liability (per-person / per-accident).\n- **PD** — Property Damage liability.\n- **UM/UIM** (`UMUIM`) — Uninsured / Underinsured Motorist.\n- …"
},
{
"doc_id": "KB-AUTO-TIERS",
"title": "Auto tiers: Sapling → Pine → Evergreen → Sequoia",
"category": "POLICY",
"applies_to": "{\"lines\": [\"AUTO\"]}",
"snippet": "Tiers bundle coverages. Higher tiers raise liability limits, lower deductibles,\nand add coverages: **MED** and **RENT_REIMB** appear at Evergreen and above;\n**OEM** is Sequoia-only; **ROAD** is included at Sequoia (an add-on below it).\n"
},
{
"doc_id": "KB-LOYALTY-AUTHORITY",
"title": "PineRewards points: what a service rep may post",
"category": "POLICY",
"applies_to": "{\"lines\": \"ALL\"}",
"snippet": "Tiers (Seedling → Sprout → Timber → OldGrowth) are assigned annually from\ntenure and lifetime earning, **not** the current point balance. Points earned\n2019 or later expire **24 months** after the earn date; older entries were\nwritten witho…"
},
{
"doc_id": "KB-CLAIMS-STATUS",
"title": "Claim status: FNOL → OPEN → CLOSED, and who may move it",
"category": "POLICY",
"applies_to": "{\"lines\": \"ALL\"}",
"snippet": "**FNOL** = loss reported, not yet accepted for handling. **OPEN** = accepted\nand with an adjuster (the adjuster sets the reserve). **CLOSED** = resolved.\nA service rep may promote FNOL → OPEN once the loss details are confirmed\nwith the cus…"
}
]
}⚙ get_doc(KB-CONDO-MASTER)
{
"doc_id": "KB-CONDO-MASTER"
}{
"doc_id": "KB-CONDO-MASTER",
"title": "Condo loss assessment & the HOA master policy",
"category": "POLICY",
"applies_to": "{\"lines\": [\"CONDO\"]}",
"body_md": "Loss Assessment coverage responds to charges levied by the HOA. Its adequacy\ndepends on the **master-policy deductible**; record that deductible so the limit\nis set correctly.\n"
}⚙ query_db(SELECT d.dwelling_id, d.type, d.hoa_master_deductible_cents, po.policy_id FRO…)
{
"sql": "SELECT d.dwelling_id, d.type, d.hoa_master_deductible_cents, po.policy_id FROM policy_objects po JOIN dwellings d ON po.object_type = 'dwelling' AND po.object_id = d.dwelling_id WHERE po.policy_id = 'POL-nc-condo-p_condo'"
}{
"rows": [],
"row_count": 0,
"truncated": false
}⚙ query_db(SELECT dwelling_id, type, year_built, construction, roof_age, sq_ft, replacem…)
{
"sql": "SELECT dwelling_id, type, year_built, construction, roof_age, sq_ft, replacement_cost_cents, protection_class, dist_to_coast_mi, hoa_master_deductible_cents FROM dwellings WHERE cust_id = 'CUST-nc-condo'"
}{
"rows": [
{
"dwelling_id": "DWL-nc-condo-d1",
"type": "condo",
"year_built": 2015,
"construction": "MASONRY",
"roof_age": 5,
"sq_ft": 1400,
"replacement_cost_cents": 21000000,
"protection_class": 4,
"dist_to_coast_mi": 8,
"hoa_master_deductible_cents": null
}
],
"row_count": 1,
"truncated": false
}I can help add it, but I can’t just attach it without the required detail. PEICO’s condo rule requires the HOA master-policy deductible to be on file for Loss Assessment coverage, because the deductible is used to set the correct limit.
Right now, your condo record does not have the HOA master deductible recorded.
For your current CONDO:PINE tier, Loss Assessment is available and the default shown in our system is $5,000, but before I add it I need the HOA master-policy deductible amount — for example, $5,000, $10,000, $25,000, etc.
Also, one important timing note: adding coverage today generally applies going forward; it may not cover a loss or assessment that has already occurred, been formally levied, or is otherwise known before the coverage is added. The exact claim decision would be made by Claims based on the assessment and loss dates.
Do you know the HOA master-policy deductible amount?
No, I don't have that number off the top of my head. I'd have to reach out to our property manager and ask, but honestly that could take a few days — they're pretty slow to respond. So what exactly do I need to get from them? Just the master-policy deductible amount, right? And once I bring that back to you, you can add the Loss Assessment coverage to my policy?
Yes — please ask the property manager for the HOA/master insurance policy deductible amount for your building or association.
Helpful wording you can send:
“Can you confirm the deductible on the HOA/master property insurance policy for our condo association, especially the deductible that would apply to storm or wind/hail damage?”
If they have more than one deductible, ask for each applicable amount, such as:
- General property/all-peril deductible
- Wind/hail or named-storm deductible
- Hurricane deductible, if separate
- Any percentage deductible and what it is based on
Once you have that deductible information, contact us again and we can review adding Loss Assessment coverage. Your current condo tier allows it, but we’ll need that master-policy deductible on file first so the coverage limit is set correctly and the policy can be repriced.
Got it — so I need to get the HOA master-policy deductible amount from the property manager, and then I can call back and you'll add the Loss Assessment coverage. That makes sense. Thanks for explaining that and for looking all this up. I'll reach out to them right away.
⚙ end_conversation()
{}{
"ok": true,
"note": "Deliver your closing message now."
}You’re welcome, Denise. Once you have the HOA master-policy deductible details, contact us and we’ll review adding Loss Assessment coverage and reprice the policy for you. Thanks for choosing PEICO, and have a good day.